In a 92-year-old patient with a progressively enlarging left mandibular mass, a normal radiograph, and smoking history, what is the most appropriate next step?

• A. Observation
• B. CT scan
• C. Biopsy
• D. Antibiotics

Answer: (C)

A persistent, enlarging mass in the jaw of an elderly patient who smokes raises strong concern for malignancy. Radiographs can be normal early in cancer, so a normal image does not exclude a malignant process. The most important next step is to obtain a tissue diagnosis through a biopsy. Histology provides definitive confirmation of cancer and guides treatment planning.

Imaging like CT can help map the extent of disease and aid surgical planning, but it does not replace tissue diagnosis. Antibiotics would address infection, not a potential cancer, and observation risks delaying a needed diagnosis.